Federal Register The Grouper software produces a five-character CMG number. Column (6) shows the estimated effect of the permanent cap on wage index decreases policy, in a budget-neutral manner. headings within the legal text of Federal Register documents. It will also support CMS' ability to compare standardized outcome measures across PAC settings. CMS, COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing, (updated March 5, 2021) (available at One of these commenters noted that IRFs could use those incentive payments to offset implementation costs, such as additional staff, licensing fees and new software and systems. Thus, we proposed to revise our teaching policy with regard to which residents can be considered displaced for the purpose of the receiving IRF's request to increase their IRF cap in the situation where an IRF announces publicly that it is closing, and/or that it is closing an IRF residency program. $75for an annual well care visit (age 3-11), $75for an annual well care visit (age 12 to 21), $75 for an annual well care visit (age 21+), $100for annual comprehensive diabetes care - must complete all of the following once in the calendar year: HbA1c test, kidney screening and retinopathy screening (dilated eye exam), $25for getting an annual flu vaccine (one per flu season September April, age 6 months and up), $25 for getting child immunizations (age 0-2), $25 for completing a lead screening (age 2), $25 for completing an annual dental exam (all ages), $75for an annual breast cancer screening (females age 50-74), $75 for an annual cervical cancer screening (females age 21-64), $75for completing a Notification of Pregnancy (NOP) form within the first trimester. States have similar programs forprescription drug benefits. The estimated impact on small entities is shown in Table 14. We intend to monitor closely whether any proposed change to the IRF QRP has unintended consequences on access to care for high risk patients. Calculate the total amount of estimated IRF PPS payments using the FY 2023 wage index values (based on updated hospital wage data and considering the permanent cap on wage index decreases policy) and the FY 2023 labor-related share of 72.9 percent. In the FY 2021 IRF PPS rulemaking cycle, CMS proposed and finalized a one-time, 1-year transition policy to mitigate the effects of adopting OMB delineations updated in OMB Bulletin 18-04 by applying a 5-percent cap on any wage index decreases compared to FY 2020 in a budget neutral manner. The Centers for Medicare & Medicaid Services (CMS) provides hospitals with reports reflecting the Hospital Value-Based Purchasing (VBP) programs impact for each fiscal year (FY). Due to the uncertainty regarding future price trends, forecast errors can be both positive and negative. To apply for the temporary increase in [42] We also proposed that, in the future, we would deviate from the IPPS IME policy as it pertains to counting displaced residents for the purposes of the IRF teaching status adjustment only when it is necessary and appropriate for the IRF PPS. the material on FederalRegister.gov is accurately displayed, consistent with Among these, there are 487 urban IRFs A free download of the Grouper software is available on the CMS website at This will ensure that the MA days are included in the hospital's Supplemental Security Income (SSI) ratio (used in calculating the IRF LIP adjustment) for FY 2007 and beyond. Finally, we applied the applicable adjustments to account for geographic variations in wages (wage index), the percentage of low-income patients, location in a rural area (if applicable), and outlier payments (if applicable) to the IRFs' unadjusted prospective payment rates. The PACIO Project has focused on HL7 FHIR implementation guides for functional status, cognitive status and new use cases on advance directives, re-assessment timepoints, and Speech, Language, Swallowing, Cognitive communication and Hearing (SPLASCH) pathology. These commenters urged CMS to engage stakeholders in developing these risk adjustment methods. An interrupted stay is defined as a stay by a patient who is discharged from the IRF and returns to the same IRF within 3 consecutive calendar days. The commenter stated that the FY 2021 and the FY 2022 market basket increases were underestimated, which suggests the base rate for IRF PPS payments for FY 2023 is 1.5 percent too low. In an effort to streamline the IRF PPS teaching status adjustment policies that were finalized in the FY 2006 IRF PPS final rule (70 FR 47928 through 47932) and the FY 2012 IRF PPS final rule (76 FR 47846 through 47848), we are codifying the longstanding policy so that these policies can be easily located by IRF providers and can also align, to the extent feasible, with the IPPS IME and IPF teaching adjustment policy regulations. Other groups of residents who, under current policy, are already considered displaced residents include, (1) Residents who are physically training in the IRF on the day prior to or day of residency program or IRF closure; and. We received comments from various trade associations, inpatient rehabilitation facilities, individual physicians, therapists, clinicians, health care industry organizations, and health care consulting firms. Clinical Practice Guideline for the Treatment of Depression. As stated previously, due to the fixed-weight nature of the index, any changes to the quantity of inputs purchased (such as increased PPE as stated by the commenter) would not be reflected in the IRF market basket update for FY 2023. Also, the rule has been reviewed by OMB. Accessed 6/3/2022. We will use this information from public commenters in conjunction with our future analysis for potential rulemaking. Federal Register provide legal notice to the public and judicial notice With regard to the comment about how most IRFs are already submitting IRF-PAI assessments on most of their patients or that if an IRF has similar section GG functional assessment average numeric change scores in their Medicare and non-Medicare patients, then there is no value in the proposal, CMS disagrees. of the proposed rule was to describe key principles and approaches that we would consider when advancing the use of quality measure development and stratification to address healthcare disparities and advance health equity across our programs. We considered not amending 412.602 and 412.624(e)(4) to codify our longstanding guidance on the teaching status adjustment policies and update the IRF teaching policy on IRF program closures and displaced residents. This includes all IRFs whose cost reporting periods begin on or after October 1, 2019, and before October 1, 2020. recommends that CMS expand the IRF transfer payment policy to apply to early discharges to home health. We invited public comments on this proposal. 482.24 Condition of Participation: Medical Record Services. This phenomenon drugs reshaping We agree with the commenters that recent higher inflationary trends have impacted the outlook for price growth over the next several quarters. The relative weight values are updated each year to ensure that the IRF case mix system is as reflective as possible of the current IRF population, thereby ensuring that IRF payments appropriately reflect the relative costs of caring for all types of IRF patients. On January 18, 2022, ONC announced a significant milestone by releasing the Trusted Exchange Framework and Common Agreement Version 1. Your username maybe be your email address. The policy adopted in the FY 2012 IRF PPS final rule (76 FR 47846 through 47848), published August 5, 2011, permits an IRF to temporarily adjust its FTE cap to reflect displaced residents added to their residency program because of another IRF closure or IRF residency program closure. Your My Health Pays reward dollars are added to your rewards card after we process the claim for each activity you complete. In the Medicare Program; Prospective Payment System for Inpatient Rehabilitation Facilities final rule that appeared in the August 7, 2001 Recommendations to minimize the information collection burden on the affected public, including automated collection techniques. However, we determined that the changes in OMB Bulletin No. IRFs must also complete a patient assessment instrument in accordance with 412.606 for each Medicare Part C (Medicare Advantage) patient admitted to or discharged from an IRF on or after October 1, 2009. Catie Cooksey, (410) 786-0179, for information about the IRF payment policies and payment rates. Based on this preliminary analysis, the impact on the cost weights through 2020 appear minimal and it is unclear whether any trends through 2020 are reflective of sustained shifts in the cost structure for IRFs or whether they were temporary as a result of the PHE. Several commenters stated that CMS did not provide enough information on how the data collection for all IRF patients, regardless of payer, would be implemented and operationalized. This covers what most people pay, including Late Enrollment Penalties (LEP) and Income Related Monthly Adjustment Amount (IRMAA). In the FY 2020 IRF PPS proposed rule (84 FR 17326 to 17327), CMS proposed to expand IRF quality data reporting on all patients regardless of payer for purposes of the IRF QRP. We appreciate the suggestions to use FY 2019 data and not FY 2021 claims data in determining the outlier threshold for FY 2023. We estimate the effects that comorbidities have on costs. These data will be used (in addition to the data collected January 1, 2024 through September 30, 2024) to calculate an IRF's data completion threshold for the FY 2026 IRF QRP. Generally, OMB issues major revisions to statistical areas every 10 years, based on the results of the decennial census. Thus, in the proposed rule, we proposed to update the IRF PPS payments for FY 2023 by a market basket increase factor as required by section 1886(j)(3)(C) of the Act based upon the most current data available, with a productivity adjustment as required by section 1886(j)(3)(C)(ii)(I) of the Act. The last four characters are numeric characters that represent the distinct CMG number. Effects of Codification and Clarifications of IRF Teaching Status Adjustment Policy, 9. Adding the result from step 3 to the national average CCR of all IRFs for which we have sufficient cost report data, from step 1. (2017). The Hospital Value-Based Purchasing (VBP) Program is part of our ongoing work to structure Medicares payment system to reward providers for the quality of care they provide. January 5, 2017. The commenter urged CMS to consider the appropriateness of this reduction in context of payment adequacy for IRFs. For example, some recipients get reimbursed for three months of Part B premiums; drug coverage goes with the approval. See CMS's Medicare Coverage Center Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Adjustments or updates to the IRF wage index made under section 1886(j)(6) of the Act must be made in a budget-neutral manner. The total change in estimated payments based on the FY 2023 payment changes relative to the estimated FY 2022 payments. Start Printed Page 47056 The IRF QRP Helpdesk is also available to providers and has been fielding questions about these new items since November 2021 when the revised compliance date for the IRF-PAI version 4.0 was finalized. We would notify stakeholders when the draft IRF PAI is available. One of these commenters opposes the collection of patient data from patients who have no connection to the Medicare program. Start Printed Page 47074 The commenter also stated that hospitals have had to increase quantities of materials such as PPE, which the commenter stated is not captured in the market basket forecasts. Comment: Additionally, in the FY 2012 IRF PPS final rule, we adopted the IPPS definition of closure of a hospital residency training program, as specified in 413.79(h)(1)(ii), which means that the hospital ceases to offer training for interns and residents in a particular approved medical residency training program. To calculate each IRF's labor and non-labor portion of the prospective payment, we begin by taking the unadjusted prospective payment rate for CMG 0104 (without comorbidities) from Table 7. Therefore, we are finalizing these revisions as proposed, with three exceptions. We thank the commenters for their suggestion to include historical outlier reconciliation dollars in the outlier projections. Relevant information about this document from Regulations.gov provides additional context. Therefore, we anticipate that the impact to the wage index budget neutrality factor in future years would continue to be minimal. In addition, this final rule codifies CMS' existing teaching status adjustment policy through amendments to the regulation text and updates and clarifies the IRF teaching policy with respect to IRF hospital closures and displaced residents. This final rule does not mandate any requirements for State, local, or tribal governments, or for the private sector. (iii) Adjustments or updates to the wage data used to adjust a facility's Federal prospective payment rate under paragraph (e)(1) of this section will be made in a budget neutral manner. Comment: These commenters stated the PHE, along with inflation, has significantly driven up operating costs. Although they acknowledged that providers' costs have increased significantly under the pandemic, they expect these costs to normalize in subsequent years and do not anticipate any long-term effects that warrant inclusion in the annual update to IRF payments in FY 2023. Baseline period means the time period during which data are collected for the purpose of calculating hospital performance on measures to establish the improvement thresholds for each measure with respect to a fiscal year. Start Printed Page 47063 Subject to the aforementioned proposal becoming final, we also proposed to revise the regulation text at 412.624(e)(1) to provide that starting October 1, 2022, CMS would apply a cap on decreases to the wage index such that the wage index applied is not less than 95 percent of the wage index applied to that IRF in the prior year. Specifically, we proposed to adopt the FY 2021 IPPS final rule definition of displaced resident as defined at 413.79(h)(1)(ii), for the purpose of calculating the IRF's teaching status adjustment. This final rule also corrects an error in the regulations text at 412.614(d)(2). An extraordinary situation may be due to, but is not limited to, fires, floods, earthquakes, or similar unusual events that inflect extensive damage to an inpatient facility. We received several comments on the concept of the HESS. documents in the last year, by the Environmental Protection Agency Response: For discharges occurring on or after October 1, 2005, the IRF PPS payment also reflects the teaching status adjustment that became effective as of FY 2006, as discussed in the FY 2006 IRF PPS final rule (70 FR 47880). This commenter stated that they believe CMS should have included pharmacists and physicians in its cost estimate in addition to increasing the percentage of time physical therapists (PTs) and occupational therapists (OTs) are involved in the process. Currently, only a small portion of the FY 2021 IRF cost report data are available for analysis, but the majority of the FY 2021 IRF claims data are available for analysis. Hauer, J., Houtrow, A.J. The RFA requires agencies to analyze options for regulatory relief of small entities, if a rule has a significant impact on a substantial number of small entities. HL7 FHIR. of the proposed rule as follows: We received 61 timely responses from the public, many of which contained multiple comments on the FY 2023 IRF PPS proposed rule (87 FR 20218). We also note that this burden may be partially offset by eliminating the effort to separate out Medicare beneficiaries from other patients, which is also burdensome. However, if the originating IRF decides to do so, then it would be the originating IRF's responsibility to determine how much of an available cap slot would go with a particular resident (if any). Fact sheet: CMS Data Element Library Fact Sheet. We invited public comment on the proposed update to the IRF CCR ceiling and the urban/rural averages for FY 2023. Gwendolyn Johnson, (410) 786-6954, for general information. documents in the last year, 10 All required data must be electronically encoded into the IRF-PAI software product. 139(6), e20171002. Commenters expressed support for CMS's intention to standardize data collection for all patients. A Go365 Wharton Study*, PDF showed that employees who engaged in the wellness and rewards program had: They can log activities, track progress and claim rewards using smartphones, tablets or desktops. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Downloads/CMS-Quality-Strategy.pdf.

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